| NPI | 1740666007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00204697) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4376) |
| Enumeration Date | 2015-08-09 |
| Last Update Date | 2021-09-14 |